Life without the ACL

Most people who are faced with
the decision of whether or not to have ACL surgery want to know what life
would be like if they were to never have their ACL fixed. There are a
lot of people out there who have had an ACL injury, decided not to have
surgery, and are leading very normal lives. There are others who didn't
have the surgery but have given up some activities that they felt they
could do without. This decision is really all about the types of activities
that you want to be able to do versus the types of activities that your
knee will let you do without giving out. Age used to be more of a factor
in deciding between surgical and non-surgical treatment of ACL injuries.
However, in the last ten years, the techniques for ACL surgery and rehabilitation
have improved. As a result, activity level is now a much more important
factor than age. Under current thinking, if you feel you could do more
if you knee were more solid, your age need not necessarily be a barrier
to surgery.

Because ACL surgery is an elective
procedure, you can wait and see how your knee functions after an ACL tear
before deciding to have surgery. Although there are exceptions to this
rule, most people with a torn ACL can safely swim, hike, bicycle, and
do other similar activities without doing further damage to their knee.
Recreational basketball, doubles tennis, and skiing, carry a bit more
risk of further knee damage or frequent episodes of the knee giving out.
Sports that involve a lot of jumping, starting and stopping and changing
direction quickly like soccer, competitive basketball, and athletic singles-tennis
have a much higher risk of causing further damage.

If you are having a hard time
deciding between having surgery and not having surgery, putting yourself
on this graph of knee looseness versus activity level can sometimes make
the decision more clear.

This graph illustrates the fact that the decision of whether or not to
have ACL surgery is unique to each individual. After an ACL injury, each
patient will have a unique combination of knee "looseness" and
the desire to return to certain activities that require a strong and stable
knee. As the amount of activity increases, the relative amount of looseness
that the knee can tolerate decreases. This graph illustrates that some
activities, to the left of the yellow line, can be performed safely after
an ACL injury, whereas some activities, to the right of the yellow line,
are more likely to require an ACL reconstruction if these sports are to
be played safely. Most people are right in the middle, able to tolerate
certain sports, like jogging and bicycling, but unable to ski competitively
or play soccer. For these individuals, the decision of whether or not
to have ACL surgery should be discussed in depth with an orthopedic surgeon.